Abstract : Keloid is a difficult-to-treat condition and an ideal treatment modality is not available. Carbon dioxide (CO 2 ) laser is one of the modalities to treat keloids. Aim : To evaluate the effect of CO 2 laser ablation followed by intralesional steroids on keloids. Settings and Design : This was a prospective, single-center, uncontrolled, open study. Materials and Methods : Twenty-eight patients having 35 keloids were included in the study. Keloids were ablated or excised with CO 2 laser followed by intralesional steroid 3-4 weeks apart for 6 months. Results were evaluated after 6 months of stopping of intralesional steroids. Statistical Analysis : Fisher's exact test was applied for obtaining difference in recurrence rate of regular and irregular patients. Results : Thirteen patients followed up regularly for intralesional steroids. During 6 months of follow-up after stoppage of steroids, only two patients showed recurrence. Ten patients were irregular for intralesional steroids and seven of them showed recurrence. Difference in recurrence rate of regular and irregular patients was significant. Conclusion : Only CO 2 laser ablation is not sufficient for halting the pathogenesis of keloid formation.We therefore conclude that CO 2 laser followed by intralesional steroid is a useful therapeutic approach for the treatment of keloids; however, patients need to be observed for recurrence over the next 1 year.

Treatment of facial skin laxity by a new monopolar radiofrequency device

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Uwe WollinaDOI:10.4103/0974-2077.79178 PMID:21572674

Background : Acquired facial skin laxity seems to be a result of the combination of intrinsic and extrinsic processes. For treatment of facial ageing, non-invasive procedures have become popular. Aim : We wanted to investigate the effect of a new 2.2-MHz radiofrequency (RF) device on acquired facial skin laxity. Setting : Outpatient clinic associated with an academic teaching hospital. Materials and Methods : We performed an open trial with the RF-ReFacing™ device (Meyer-Haake Medical Innovations, Wehrheim/ Germany) in the monopolar mode with a power of 8-12 W, two passes per session and repetition three times after 2 weeks without treatment. Results : A total of 20 Caucasian female patients were included (age range, 34-73 years). The procedure was performed without any analgesia. We did not see any adverse effect. The procedure was scored as most convenient or convenient by all patients. Improvement in skin laxity and fine wrinkles was seen after the second treatment in 19 of the 20 patients and after the third treatment in 100% of the patients. On a scale from 0 to 3, improvement in the lower lid, Crow's feet and jowl line was scored 2.6±0.7 by the patients; improvement in the overall appearance of the face was scored 2.3±0.5. Blinded assessment of the photographs rated the improvement as good or better in 15 of the 20 patients, moderate in 3 patients, no change in 1 patient. Conclusions : RF-ReFacing™ treatment was effective in improvement in skin laxity. Patients' satisfaction was high. Although RF-ReFacing™ treatment cannot substitute surgical procedure, it might prolong the time to the first surgical facial lift. The number of patients treated was small, and no quantitative measurements or histopathology was performed. Hence further studies with greater number of patients are necessary.

Objective : Biological dressings like collagen are impermeable to bacteria, and create the most physiological interface between the wound surface and the environment. Collagen dressings have other advantages over conventional dressings in terms of ease of application and being natural, non-immunogenic, non-pyrogenic, hypo-allergenic, and pain-free. This study aims to compare the efficacy of collagen dressing in treating burn and chronic wounds with that of conventional dressing materials. Materials and Methods : The records of 120 patients with chronic wounds of varied aetiologies and with mean age 43.7 years were collected and analyzed. The patients had been treated either with collagen or other conventional dressing materials including silver sulfadiazine, nadifloxacin, povidone iodine, or honey (traditional dressing material). Patients with co-morbidities that could grossly affect the wound healing like uncontrolled diabetes mellitus, chronic liver or renal disease, or major nutritional deprivation were not included. For the purpose of comparison the patients were divided into two groups; 'Collagen group' and 'Conventional group', each having 60 patients. For assessment the wound characteristics (size, edge, floor, slough, granulation tissue, and wound swab or pus culture sensitivity results) were recorded. With start of treatment, appearance of granulation tissue, completeness of healing, need for skin grafting, and patients' satisfaction was noted for each patient in both groups. Results : With two weeks of treatment, 60% of the 'collagen group' wounds and only 42% of the 'conventional group' wounds were sterile (P=0.03). Healthy granulation tissue appeared earlier over collagen-dressed wounds than over conventionally treated wounds (P=0.03). After eight weeks, 52 (87%) of 'collagen group' wounds and 48 (80%) of 'conventional group' wounds were >75% healed (P=0.21). Eight patients in the 'collagen group' and 12 in the 'conventional group' needed partial split-skin grafting (P=0.04). Collagen-treated patients enjoyed early and more subjective mobility. Conclusion : No significant better results in terms of completeness of healing of burn and chronic wounds between collagen dressing and conventional dressing were found. Collagen dressing, however, may avoid the need of skin grafting, and provides additional advantage of patients' compliance and comfort.

Non-cultured epidermal cellular grafting is an innovative surgical technique that can be used for the treatment of stabilized leucoderma, including vitiligo. Many reports have been published since its introduction in 1992, including several modifications and simplification of the original technique. This systematic review gives an overview of the literature.

Introduction : Autologous non-cultured basal cell-enriched epidermal cell suspension transplantation is a simple yet effective cell-based therapy for vitiligo. Materials and Methods : This report is a retrospective analysis of 58 patients who were operated between December 2003 and August 2006 and were under follow-up for at least 2 years. Nine patients did not come for follow-up, and were excluded. At the time of transplantation all patients were having stable disease for at least 1 year. Epidermal cell suspension transplantation was done using Mulekar's method. Repigmentation was assessed and classified into excellent (>90% repigmentation), good (70-89%), fair (30-69%) and poor (<30%). Results : Of the 49 patients who came for follow-up, 32 (65%) had excellent (>90%) repigmentation; 9 (18%) had good (70-89%); 4 (8%) had fair (30-69%) and 4 (8%) patients had poor (<30%) repigmentation. During the follow-up, eight patients(16%) showed relapse of the disease. Conclusion : Autologous noncultured basal cell-enriched epidermal cell suspension transplantation is an effective, simple and safe method.

Background : Nevus depigmentosus is a congenital, nonprogressive hypopigmented disorder. Various therapeutic methods have been attempted to repigment nevus with variable results. Objective : The objective of this study is to report our experience of treatment of nevus depigmentosus with a combination of noncultured melanocyte-keratinocyte transplantation (MKTP) and excimer laser sessions. Materials and Methods : Six patients (male 1, female 5) of nevus depigmentosus were treated with a combination of noncultured melanocyte-keratinocyte transplantation and excimer laser. One patient was lost to follow-up. Remaining five patients were observed for a period ranging from 7 to 30 months. Results : Two patients responded poorly to MKTP. The remaining three patients responded with repigmentation ranging from 80% to 100% but the quality of repigmentation was unsatisfactory in two of them. Conclusion : Though repigmentation of nevus depigmentosus is possible by grafting techniques, the results are inconsistent and recurrence is possible.

Background : Vitiligo has a devastating psychosocial effect. The cultural traditions of Saudi society are quite different compared with the western world. Hence, a quality of life study using a different questionnaire suitable to the cultural traditions of the society is necessary to measure qualify of life in vitiligo patients. Objective : This study was conducted to assess the quality of life (QOL) in Saudi vitiligo patients and their family. Materials and Methods : A prospective cross-sectional study at National Center for Vitiligo and Psoriasis, Saudi Arabia. A validated Arabic questionnaire of 41 questions was developed and utilized specifically for this study. Arabic language instrument was distributed to 260 vitiligo patients. Scores were compared in relation to demographic, clinical, and social variables in 4 dimensions of scale (relationship with colleagues, family relationship, social relationship, and self respect). Results : Overall score QOL was 17.1. Mean score for males was 11.1, whereas that for females was 23.9 (P < 0.05). Females scored significantly higher in all the 4 dimensions. Patients with exposed disease lesions scored significantly higher than those with unexposed lesions 5 vs 3.4 (P < 0.05). Conclusion : The overall score of QOL in vitiligo is relatively high, indicating a negative impact of the disease on QOL. QOL in women is significantly more affected than in men.

Background : Vitiligo is an acquired disorder of depigmentation. Various surgical modalities are recommended for quicker resolution of lesions in stable cases. Aim : To report the efficacy of split thickness skin grafting in a series of 50 patients with stable vitiligo. Materials and Methods : Fifty patients with stable vitiligo, not responding to adequate trial of medical line of treatment were taken in this prospective study. After doing complete investigations, including coagulogram, they were subjected to split thickness skin grafting. Result : Satisfactory cosmetic results were obtained in all cases. Colour match was good with minimal complications reported. Conclusion : Split thickness skin grafting remains a promising option for patients with stable recalcitrant vitiligo. Limitations : Comparison of efficacy and side effects of various vitiligo surgical modalities was not done.

Follicular unit transplant (FUT) is one of the surgical procedures which has been recently used to repigment a stable vitiligo patch. Single-hair FUT was done for a 30-year-old male with stable vitiligo patch on the upper lip. Repigmentation was noted in 4 weeks and complete pigmentation seen at 8 weeks. No recurrence was noted at the end of 6-month follow-up with excellent colour match. This case is presented to highlight the effectiveness of FUT in focal vitligo patch with leukotrichia.

Epidermal cell suspensions are being increasingly used in the surgical management of vitiligo. The procedure suffers from several drawbacks such as high cost of the procedure, difficulty of procuring the reagents etc. We hereby describe modifications which allow the use of cheaper, more commonly available alternatives.

A 72-year-old male presented with a large ulceroproliferative lesion over left gluteal region. After histopathological confirmation of squamous cell carcinoma, the lesion was excised with wide margins. Further histopathological study of the excised specimen revealed the growth arising from an epidermal cyst. Malignant change is a rare, but wellknown complication occurring in an epidermal cyst. The mainstay of treatment consists of wide excision of cancerous lesion with primary reconstruction of the defect.

Malignant proliferating trichilemmal tumour is a rare cutaneous malignant neoplasm usually occurring in elderly women. We present a case of malignant trichilemmal tumour in a young lady of 26 years of age with a previous history of proliferating trichilemmal tumour at the same site.

Post-axial polydactyly is a common congenital hand anomaly with a wide range of manifestations. We report here an unusual case of intra-natal torsion of duplicated small finger which presented as gangrene at birth.

Laugier-Hunziker syndrome (LHS) is an acquired, benign pigmentary skin condition involving oral cavity including lower lip in the form of brown black macules 1-5 mm in size, frequently associated with longitudinal melanonychia. There is no underlying systemic abnormality or malignant predisposition associated with LHS, and therefore the prognosis is good. Important differential diagnoses include Peutz Jeghers syndrome and Addison's disease among other causes of oral and acral pigmentation. Treatment is sought mainly for cosmetic reasons and Q-switched Nd-Yag laser/ Q-switched alexandrite therapy and cryosurgery have been tried with varying success.

Congenital nevi are present in approximately 2-3% of neonates. These lesions are present at birth. They are characterized by pigmented lesions with regular margins, smooth or lobular surfaces and occasionally have long coarse hair. The risk of melanoma development is proportional to the size, especially if it involves over 5% of the body surface, or is > 20 cm in adolescents (large/giant congenital nevus). The risk of malignant change ranges from 5-40%. We present a case of a congenital melanocytic nevus in a six-year-old female child which was surgically treated.